What is labyrinthitis. How does it affect balance and hearing. What are the main causes of labyrinthitis. How is labyrinthitis diagnosed and treated. Can labyrinthitis recur. What lifestyle changes can help manage labyrinthitis symptoms.

Understanding Labyrinthitis: An Overview of Inner Ear Inflammation

Labyrinthitis is a condition characterized by inflammation of the inner ear’s labyrinth, a complex system of fluid-filled tubes and sacs that play a crucial role in maintaining balance and hearing. This inflammation can also affect the vestibulocochlear nerve, also known as the eighth cranial nerve, which transmits information from the inner ear to the brain. Labyrinthitis typically affects one ear and can cause a range of disruptive symptoms that impact a person’s daily life.

Key Components of the Inner Ear

• Labyrinth: A system of fluid-filled tubes and sacs
• Cochlea: Responsible for gathering sound information
• Vestibular organs: Collect data on motion and spatial changes
• Eighth cranial nerve: Transmits information from the inner ear to the brain

When inflammation occurs in these delicate structures, it can disrupt the normal flow of information, leading to the characteristic symptoms of labyrinthitis.

Recognizing the Symptoms of Labyrinthitis

Labyrinthitis can manifest with a variety of symptoms, some of which can be quite alarming for those experiencing them. The onset of these symptoms is often sudden and without warning, which can be particularly distressing.

Common Symptoms of Labyrinthitis

• Vertigo: A spinning sensation or feeling that you or your surroundings are moving
• Dizziness: A general feeling of unsteadiness or lightheadedness
• Hearing loss: This can range from mild to severe
• Tinnitus: Ringing or buzzing in the ears
• Nausea and vomiting: Often accompanied by vertigo
• Balance problems: Difficulty maintaining equilibrium
• Visual disturbances: Trouble focusing or tracking objects with your eyes

Are these symptoms always indicative of labyrinthitis. While these symptoms are characteristic of labyrinthitis, they can also be associated with other conditions. Therefore, it’s crucial to consult a healthcare professional for an accurate diagnosis if you experience any of these symptoms, especially if they occur suddenly or persist.

Exploring the Causes of Labyrinthitis

Labyrinthitis can be triggered by various factors, with viral infections being the most common cause. Understanding the underlying causes can help in prevention and guide treatment approaches.

Viral Labyrinthitis

Viral labyrinthitis is more prevalent than its bacterial counterpart. It can be associated with several viral infections, including:

• Measles
• Mumps
• Hepatitis
• Herpes viruses (those causing cold sores, chicken pox, or shingles)
• Influenza and other upper respiratory infections

Viral labyrinthitis typically affects only one ear and may seem to resolve quickly, only to return unexpectedly later.

Bacterial Labyrinthitis

While less common, bacterial labyrinthitis can occur through two primary mechanisms:

1. Toxins from a middle ear infection spreading to the inner ear
2. Infections in the surrounding bones producing toxins that affect the inner ear

Chronic middle ear infections can lead to bacterial labyrinthitis. In rare cases, bacteria can directly invade the labyrinth from outside the ear, often as a complication of conditions like bacterial meningitis.

Diagnosing Labyrinthitis: Challenges and Approaches

Diagnosing labyrinthitis can be challenging as there are no specific tests that definitively confirm the condition. Instead, healthcare providers often use a process of elimination, ruling out other conditions that may present with similar symptoms.

Diagnostic Process

• Medical history review
• Physical examination
• Hearing tests
• Balance tests
• Imaging studies (CT or MRI scans) to rule out other conditions

How do doctors differentiate between viral and bacterial labyrinthitis. Distinguishing between viral and bacterial causes can be difficult due to the similarity in symptoms. In some cases, laboratory tests or the response to initial treatments may help determine the underlying cause.

Conditions to Rule Out

During the diagnostic process, healthcare providers may need to exclude other conditions that can mimic labyrinthitis, such as:

• Benign paroxysmal positional vertigo (BPPV)
• Meniere’s disease
• Vestibular neuritis
• Acoustic neuroma
• Stroke or transient ischemic attack (TIA)

Treatment Strategies for Labyrinthitis

The treatment of labyrinthitis depends on its underlying cause and the severity of symptoms. The primary goals of treatment are to address the infection (if present), manage symptoms, and support recovery.

Medications

• Antiviral drugs: For suspected viral causes
• Antibiotics: In cases of bacterial labyrinthitis
• Corticosteroids: To reduce inflammation
• Antiemetics: To control nausea and vomiting
• Vestibular suppressants: To alleviate vertigo and dizziness

What role do steroids play in treating labyrinthitis. Steroids like cortisone can help reduce inflammation in the inner ear, potentially speeding up recovery and minimizing long-term complications.

Non-Pharmacological Approaches

In addition to medications, several non-pharmacological strategies can aid in recovery:

• Vestibular rehabilitation exercises: To improve balance and reduce dizziness
• Physical therapy: Focused on balance and coordination
• Rest and hydration: To support the body’s natural healing processes
• Stress reduction techniques: As stress can exacerbate symptoms

Recovery and Prognosis: What to Expect

The recovery process from labyrinthitis can vary significantly among individuals. While some may experience a full recovery within a few weeks, others may have symptoms that persist for months.

Typical Recovery Timeline

• Acute phase: 1-3 weeks with severe symptoms
• Subacute phase: 1-3 months with gradual improvement
• Chronic phase: Beyond 3 months, if symptoms persist

Can labyrinthitis lead to permanent damage. In most cases, labyrinthitis resolves completely without lasting effects. However, some individuals may experience residual symptoms or recurrent episodes of vertigo.

Potential Long-Term Effects

While rare, some individuals may experience long-term complications from labyrinthitis, including:

• Permanent hearing loss
• Chronic balance problems
• Persistent tinnitus

Regular follow-up with healthcare providers and adherence to recommended treatments can help minimize the risk of long-term complications.

Managing Daily Life with Labyrinthitis

Living with labyrinthitis can be challenging, especially during the acute phase of the condition. Implementing certain lifestyle changes and precautions can help manage symptoms and reduce the risk of accidents.

Safety Precautions

• Remove tripping hazards from your home, such as area rugs and electrical cords
• Install non-slip mats in bathrooms and showers
• Use nightlights to navigate safely during nighttime
• Avoid sudden movements, particularly of the head
• Use assistive devices like a cane or walker if necessary

Lifestyle Adjustments

Making certain changes to your daily routine can help alleviate symptoms and support recovery:

• Stay hydrated and maintain a balanced diet
• Avoid caffeine, alcohol, and tobacco
• Reduce salt intake, as it can affect fluid balance in the inner ear
• Get adequate rest and sleep
• Practice stress-reduction techniques like meditation or deep breathing exercises

How can you manage vertigo episodes at home. If you experience a sudden onset of vertigo, lie down immediately in a quiet, darkened room with your eyes closed. This can help reduce the intensity of the spinning sensation.

Preventing Recurrence and Complications

While it’s not always possible to prevent labyrinthitis, certain measures can reduce the risk of recurrence or complications.

Preventive Strategies

• Maintain good hygiene to reduce the risk of viral infections
• Stay up-to-date with vaccinations
• Manage chronic conditions that may increase susceptibility to infections
• Seek prompt treatment for ear infections to prevent spread to the inner ear
• Follow up regularly with your healthcare provider

Is it possible to build immunity against labyrinthitis. While you can’t develop immunity to labyrinthitis itself, maintaining a strong immune system through a healthy lifestyle can help prevent the infections that may lead to labyrinthitis.

When to Seek Medical Attention

It’s important to know when to seek medical help, especially if you experience:

• Sudden, severe vertigo or dizziness
• Rapid onset of hearing loss
• Persistent or worsening symptoms despite treatment
• New or unusual symptoms
• Signs of potential complications, such as facial weakness or severe headaches

Prompt medical attention can help prevent complications and ensure appropriate management of labyrinthitis.

Understanding labyrinthitis, its causes, symptoms, and management strategies can empower individuals to navigate this challenging condition more effectively. By working closely with healthcare providers and implementing appropriate lifestyle changes, many people with labyrinthitis can achieve significant improvement in their symptoms and quality of life. Remember that each case is unique, and personalized care is essential for optimal outcomes.

Symptoms, Causes, Types, Diagnosis, Treatment

When your inner ear gets infected or inflamed, it can cause a type of balance disorder known as labyrinthitis. Sometimes you can get it when you have an upper respiratory infection, like the flu.

Inner ear infections that lead to labyrinthitis are usually caused by a virus. Sometimes bacteria can cause it, too. The symptoms of viral and bacterial infections can be so similar that a doctor needs to confirm which type you have before they can treat it

What Causes It?

Your inner ear contains a system of loopy tubes and sacs called the labyrinth. It contains some fluid and hair cells. It also controls your balance and hearing. An infection can disrupt information that flows from this area to your brain.

What Are the Symptoms?

Labyrinthitis can not only affect your hearing, it can also make you feel dizzy. You might experience something more severe, like vertigo. This is the sudden feeling that you or the inside of your head is spinning.

Other symptoms might include:

Symptoms often appear without warning. For instance, you might notice them when you wake up one morning. This can be scary. If you feel lightheaded, or have trouble with your balance or vision, call your doctor or go to the ER right away.

Viral Labyrinthitis

This form of the infection is more common than bacterial. But doctors know less about it. Some viruses seem to be linked. These include measles, mumps, hepatitis, and the types of herpes that cause cold sores, chicken pox, or shingles.

If you have viral labyrinthitis, it usually will affect only one ear. It might quickly run its course and seem to go away. But it can return without warning.

Bacterial Labyrinthitis

This can happen in one of two ways: First, bacteria from a middle ear infection make toxins that get into the inner ear and cause inflammation and swelling. Or second, an infection in the bones surrounding the inner ear makes toxins that cause the same symptoms.

A chronic, or ongoing, middle ear infection can cause it.

A more severe and uncommon type of bacterial labyrinthitis occurs when germs invade the labyrinth from outside the ear. A condition like bacterial meningitis can be the cause of this type.

How Is It Diagnosed?

There aren’t any specific tests that let your doctor know you have labyrinthitis. They’ll first rule out other conditions that mimic it. They may want to test for health issues like:

What’s the Treatment?

If your doctor rules out bacteria as the cause, they might prescribe antiviral meds or those that control swelling. Steroids like cortisone can help, too.

You might also need medication to treat your symptoms, such as nausea or vertigo.

Special exercises can help you regain your balance. A physical therapy program that focuses on this can speed up your recovery.

Recovery

It might take a while — from a few weeks to months — but most people recover completely from labyrinthitis. It’s possible to have another bout of vertigo later on. This can happen if you turn over in bed or even tilt your head a certain way. Physical therapy can help you get better.

Will It Come Back?

It may, but it might be a milder case. Your doctor likely will look for another cause for your symptoms at this point.

What Can I Do About My Symptoms?

• Don’t move too quickly — you might lose your balance.
• Remove tripping hazards like area rugs and electrical cords. Put non-slip mats in your bath and shower.
• If you start to feel dizzy, lie down right away. People with vertigo often feel better if they lie down in a quiet, darkened room with their eyes closed.
• Drink lots of fluids and eat well. Avoid caffeine, alcohol, salt, and tobacco.
• If you think your meds are making you feel dizzy, talk to your doctor. They may change your dose, have you stop using them, or try something else.
• Don’t drive if you have dizzy spells.

Labyrinthitis | Cedars-Sinai

Not what you’re looking for?

What is labyrinthitis?

Labyrinthitis is the inflammation
of part of the inner ear called the labyrinth. The eighth cranial nerve
(vestibulocochlear nerve) may also be inflamed. The inflammation of these causes a
feeling of spinning (vertigo), hearing loss, and other symptoms. In most people, these
symptoms go away over time. It is not a common condition. It often only affects one
ear.

The inner ear has a system of
fluid-filled tubes and sacs called the labyrinth. Inside the inner ear, the cochlea
gathers information about sound. The vestibular organs gather information about motion
and changes in space. These all help to create a sense of balance. The eighth cranial
nerve sends all of this information from the inner ear to the brain.

When one of the nerves or the labyrinth is infected, it can become inflamed and
irritated. This can cause it to not work normally. It may cause hearing loss in one ear.
The brain now has to make sense of the information that doesn’t match between the normal
nerve and the infected one. This causes vertigo.

What causes labyrinthitis?

A viral infection of the eighth
cranial nerve or labyrinth may cause the condition. The virus may have spread all over
your body. Or it may only affect the eighth cranial nerve and labyrinth. In most cases
only one nerve is affected. Viruses known to cause labyrinthitis include:

• Herpes viruses
• Influenza
• Measles
• Mumps
• Rubella
• Polio
• Hepatitis
• Epstein-Barr
• Varicella

Bacterial infections of the middle
ear are fairly common in children. In rare cases, an infection in the middle part of the
ear can spread to the inner ear and cause labyrinthitis. This is more of a risk with
middle-ear infections that are long-lasting (chronic) and not treated. In rare cases,
bacterial meningitis or a head injury may cause labyrinthitis. In other cases, the cause
is not known.

Who is at risk for labyrinthitis?

Having a viral infection that can
cause labyrinthitis increases your risk. Your child’s risk may increase if he or she
hasn’t had the recommended vaccines.

What are the symptoms of labyrinthitis?

Symptoms of labyrinthitis may
include:

• A feeling of spinning (vertigo)
• Dizziness
• Lack of balance when walking
• Nausea and vomiting
• Not able to focus (concentrate)
• Periods of uncontrolled, back-and-forth eye movements (nystagmus)
• Hearing loss
• Ringing in the ears

Your symptoms might range from mild to severe. They may come on very quickly. In many
people, these symptoms go away over several weeks. Others have symptoms that last
longer.

A related syndrome is called
vestibular neuritis. It causes similar symptoms. But it does not cause hearing problems.
It affects only the vestibular part of the labyrinth and nerve.

Labyrinthitis does not cause
neurological symptoms such as severe headache, speech problems, or loss of arm or leg
movement.

How is labyrinthitis diagnosed?

Your healthcare provider will ask
about your health history. You may also have a physical exam. This may include hearing
and balance tests. It will also include an exam of your nervous system. Many
neurological and other health conditions can cause dizziness and vertigo. Your
healthcare provider may need to rule these out.

There are no tests for labyrinthitis. But your provider may have you take an imaging
test. This can help to rule out other causes of your symptoms, such as stroke.

You may have tests such as:

• MRI. This is done to rule out stroke.
• Electrocardiogram (ECG) or other cardiovascular tests. These can
  rule out cardiovascular causes.
• Electronystagmography (ENG) or
  videonystagmography (VNG). These record your eye movement. This helps to find
  the exact area of the problem in your vestibular system and evaluate the cause of
  your balance disorder.

How is labyrinthitis treated?

Treatment will depend on your symptoms, age, and general health. It
will also depend on how severe the condition is.

Immediate treatment for
labyrinthitis might include:

• Corticosteroid medicines (to help
  reduce nerve inflammation)
• Antiviral medicines
• Antibiotics (if there are signs of a
  bacterial infection)
• Medicines to take for a short time
  that control nausea and dizziness (such as diphenhydramine and lorazepam)

If your symptoms go away in a few
weeks, you likely won’t need other treatment. If you have symptoms that don’t go away,
you may need to do certain exercises. These are known as vestibular rehabilitation
exercises. They are a form of physical therapy. These exercises may help your brain
learn to adjust to the vestibular imbalance.

What are possible complications of labyrinthitis?

In most cases, labyrinthitis does
not cause any problems. In rare cases, labyrinthitis causes lasting (permanent) damage
to the eighth cranial nerve. This can cause lasting problems with balance, and part or
total hearing loss. You might need to use a hearing aid. Get treatment right away to
help reduce your risk for these complications.

When should I call my healthcare provider?

Call your healthcare provider if
your symptoms get worse or don’t begin to go away after a few days of treatment. Also
call your healthcare provider right away if you have new symptoms, such as trouble
moving an arm or a leg.

Key points about labyrinthitis

• Labyrinthitis often results from a
  viral infection of the eighth cranial nerve or the labyrinth.
• Symptoms include vertigo, hearing
  loss, and dizziness. Symptoms may start suddenly and go away in a few weeks.
• Your healthcare provider will need to
  rule out other more dangerous causes of vertigo, such as stroke.
• You might need medicines to treat your
  symptoms.
• If your symptoms don’t go away, you may need rehab exercises to
  help your brain adjust to the vestibular imbalance.
• In rare cases, this condition can
  cause permanent hearing loss and ongoing vertigo.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider
  tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines,
  treatments, or tests. Also write down any new instructions your provider gives
  you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also
  know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or
  procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that
  visit.
• Know how you can contact your provider if you have questions.

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Causes, symptoms, treatment, and recovery

Labyrinthitis is an inner ear infection that can affect a person’s balance and hearing. It may occur when a cold, the flu, or a middle ear infection spreads to the inner ear.

This article will cover the causes, symptoms, diagnosis, and treatment of labyrinthitis.

The inner ear, also known as the labyrinth, is responsible for both hearing and balance. The labyrinth consists of two main parts:

• The cochlea is a small, snail-shaped structure that converts sound vibrations into nerve impulses that travel to the brain.
• The vestibular system consists of a complex network of semicircular canals that play an important role in maintaining balance by providing information about the body’s spatial orientation.

Both the cochlea and vestibular system send information to the brain via the vestibulocochlear nerve.

Labyrinthitis is an infection of the inner ear. It causes inflammation that can affect the structures of this part of the ear and disrupt the flow of sensory information from the ear to the brain. This disruption can result in a range of symptoms, including dizziness, vertigo, and even hearing loss.

Viral infections are the most common cause of labyrinthitis, but the condition can sometimes result from a bacterial infection.

While both types of infection can cause similar symptoms, bacterial labyrinthitis is generally more severe than viral labyrinthitis. The treatments for the two are very different, so it is important that a person gets the correct diagnosis from a doctor.

Anyone can develop labyrinthitis, but some conditions can increase the risk. These include:

• upper respiratory infections, such as the common cold and the flu
• middle ear infections
• meningitis
• head injuries
• respiratory illnesses, such as bronchitis
• viral infections, including herpes and measles
• autoimmune conditions

Other factors that may increase the likelihood of labyrinthitis include:

• smoking
• heavy alcohol consumption
• a history of allergies
• stress
• use of specific medications

Share on PinterestSymptoms of labyrinthitis can include tinnitus, hearing problems, dizziness, and nausea.

The symptoms of labyrinthitis can appear suddenly and without warning. Some people with this infection may experience symptoms that last for a few weeks but then disappear on their own.

However, other people may experience long-term or reoccurring symptoms that appear when they move their head suddenly.

Symptoms of labyrinthitis include:

• dizziness
• vertigo, which gives a person the sensation of spinning or the world spinning around them
• tinnitus, which is ringing in the ears
• nausea
• loss of balance
• hearing or vision problems

There are several different types of labyrinthitis, which we cover in more detail below.

Viral labyrinthitis

Most cases of labyrinthitis are due to viral infections, such as a cold or the flu, spreading to the inner ear. Viral labyrinthitis typically results in sudden vertigo, nausea, and vomiting. Sometimes, it also leads to hearing loss.

Viral labyrinthitis usually goes away on its own. Medications for this form of labyrinthitis aim to relieve symptoms, such as dizziness and nausea.

Bacterial labyrinthitis

There are two main types of bacterial labyrinthitis:

Serous labyrinthitis

Also called toxic labyrinthitis, serous labyrinthitis commonly results from a bacterial infection in the middle ear, which doctors refer to as chronic otitis media (COM). COM causes a fluid buildup in the middle ear, which can progress to the inner ear if a person does not receive treatment.

Serous labyrinthitis is the less severe type of bacterial labyrinthitis, and hearing loss only affects high-frequency sounds. The symptoms of serous labyrinthitis include:

• mild vertigo
• nausea or vomiting

Suppurative labyrinthitis

This form of labyrinthitis occurs when bacteria in the middle ear enter the inner ear. The symptoms are more severe than those of serous labyrinthitis, and they typically affect just one of the ears.

Symptoms of suppurative labyrinthitis include:

• severe vertigo
• nausea and vomiting
• tinnitus
• nystagmus, which is a condition that causes repetitive and uncontrolled eye movements
• hearing loss

A person should see a doctor as soon as any symptoms of labyrinthitis appear. Labyrinthitis can resolve without treatment, but determining the cause of the condition is key to preventing long-lasting complications.

A doctor can determine whether a viral or bacterial infection is responsible for the symptoms. They may prescribe antibiotics for bacterial labyrinthitis.

Even if the labyrinthitis clears on its own, it is a good idea to ask a doctor to assess whether or not the condition has caused any permanent damage.

There are no specific tests to diagnose labyrinthitis. A doctor will usually carry out a thorough physical examination and neurological evaluation to rule out any other conditions, such as:

Rarely, structural abnormalities inside a person’s head can cause symptoms of labyrinthitis. To rule these out, a doctor may recommend imaging tests, such as a CT or MRI scan.

Share on PinterestOver-the-counter antihistamines may ease some of the symptoms of viral labyrinthitis.

The purpose of labyrinthitis treatment is to relieve symptoms. A person can take over-the-counter antihistamines to ease some of the symptoms of viral labyrinthitis, such as nausea or dizziness. Stronger antihistamines, such as meclizine or promethazine, are available on prescription.

A doctor may also prescribe corticosteroids or sedatives for people with more severe symptoms. In cases where a bacterial infection is responsible for labyrinthitis, they may prescribe antibiotics.

If symptoms persist for several months, the doctor may need to check the individual for signs of permanent hearing damage. Following this, they can advise on whether or not a hearing aid may be helpful.

When labyrinthitis is chronic, or long-term, a person may benefit from a type of physical therapy called vestibular rehabilitation. This therapy involves exercises that aim to improve balance and reduce dizziness.

Therapists typically tailor vestibular rehabilitation to an individual’s specific needs, but some common exercises include:

• moving the eyes up and down and from side to side
• bending the head forward and backward
• turning the head from side to side
• bending the torso forward
• leaning the torso over to each side
• catching and throwing a ball
• walking up and down on an incline

Most people can perform vestibular rehabilitation exercises at home, but a specialized physical therapist will monitor their progress and make any necessary modifications to the exercises.

Early diagnosis and treatment of labyrinthitis can reduce the risk of permanent damage to the inner ear. Severe cases of labyrinthitis can result in permanent damage to the vestibular system and varying degrees of hearing loss.

Labyrinthitis can also lead to a condition known as benign paroxysmal positional vertigo (BPPV). BPPV is a type of vertigo that results from sudden movements of the head. This condition is not life-threatening, but it can increase a person’s risk of falls.

Labyrinthitis is not life-threatening. In most cases, hearing and balance return to normal over time. Symptoms of vertigo and dizziness usually only last for a few days.

Most people make a full recovery provided that they receive proper treatment, especially for bacterial labyrinthitis. Recovery from labyrinthitis usually takes a few weeks.

While recovering from labyrinthitis, a person should rest and avoid any sudden movements of the head. As this condition can significantly affect a person’s balance and coordination, it is also essential to avoid driving and operating potentially dangerous machinery.

During a vertigo attack, a person should try to remain calm and avoid unnecessary movement. It is best to avoid bright lights and television or computer screens during an attack. Instead, find a quiet place to sit down and wait for it to pass.

People who experience chronic labyrinthitis should speak with their doctor about other treatment options, such as vestibular rehabilitation.

Labyrinthitis is an infection of the inner ear that can cause nausea and affect a person’s balance and hearing. Although symptoms typically resolve on their own within a few weeks, it is important to see a doctor for a proper evaluation.

A doctor can prescribe medications to relieve symptoms and aid recovery. In severe cases, untreated labyrinthitis can lead to serious long-term health complications, such as permanent damage to the inner ear and hearing loss.

Labyrinthitis – Illnesses & conditions

Labyrinthitis is usually treated using a combination of self-help techniques and medication. Chronic labyrinthitis may be treated with vestibular rehabilitation therapy (VRT).

Self-help

Drink plenty of liquid, little and often, particularly water, to avoid becoming dehydrated.

In its early stages, you may feel constantly dizzy and it can give you severe vertigo. You should rest in bed to avoid falling and injuring yourself. After a few days, the worst of these symptoms should have passed and you should no longer feel dizzy all the time.

You can do several things to minimise any remaining feelings of dizziness and vertigo. For example:

• during an attack, lie still in a comfortable position (on your side is often best)
• avoid alcohol
• avoid bright lights
• try to cut out noise and anything that causes stress from your surroundings

You should also avoid driving, using tools and machinery or working at heights if you’re feeling dizzy and unbalanced.

Medication

If your dizziness, vertigo and loss of balance are particularly severe, your GP may prescribe a short course of medication such as benzodiazepine or antiemetics (vestibular sedatives).

Benzodiazepine

Benzodiazepines reduce activity inside your central nervous system. This means your brain is less likely to be affected by the abnormal signals coming from your vestibular system.

However, long-term use of benzodiazepines is not recommended because they can be highly addictive if used for long periods.

Antiemetics

A prescription medication known as an antiemetic may be prescribed if you’re experiencing nausea and vomiting.

Prochlorperazine 5mg tablets are an antiemetic used to treat the symptoms of vertigo and dizziness. It may be considered as an alternative treatment to benzodiazepines.

Most people are able to tolerate prochlorperazine and side effects are uncommon, but can include:

• tremors (shaking)
• abnormal or involuntary body and facial movements
• sleepiness

If you are vomiting, there is a prochlorperazine 3mg tablet available which you place inside your mouth between your gums and cheek.

Corticosteroids

Corticosteroids such as prednisolone may be recommended if your symptoms are particularly severe. They are often effective at reducing inflammation.

Antibiotics

If your labyrinthitis is thought to be caused by a bacterial infection, you will be prescribed antibiotics. Depending on how serious the infection is, this could either be antibiotic tablets or capsules (oral antibiotics) or antibiotic injections (intravenous antibiotics).

Check the patient information leaflet that comes with your medicines for a full list of possible side effects.

When to seek further advice

Contact your GP if you develop additional symptoms that suggest your condition may be getting worse. If this happens, you may be admitted to hospital. These symptoms include:

• mental confusion
• slurred speech
• double vision 
• weakness or numbness in one part of your body
• a change in the way you usually walk

Also contact your GP if you do not notice any improvement after three weeks. You may need to be referred to an ear, nose and throat (ENT) specialist.

Chronic labyrinthitis

A small number of people experience dizziness and vertigo for months or even years. This is sometimes known as chronic labyrinthitis.

The symptoms are not usually as severe as when you first get the condition, although even mild dizziness can have a considerable impact on your quality of life, employment and other daily activities.

Vestibular rehabilitation therapy (VRT)

Vestibular rehabilitation therapy (VRT) is an effective treatment for people with chronic labyrinthitis. VRT attempts to “retrain” your brain and nervous system to compensate for the abnormal signals coming from your vestibular system.

VRT is usually carried out under the supervision of a physiotherapist and involves a range of exercises designed to:

• co-ordinate your hand and eye movements
• stimulate sensations of dizziness so your brain starts to get used to disruptive signals sent by your vestibular system and then ignores them
• improve your balance and walking ability
• improve your strength and fitness

The Brain and Spine Foundation is a UK charity that has more information about vestibular rehabilitation on its website.

You can ask your GP to refer you to a physiotherapist or you can pay for private treatment. If you decide to see a private physiotherapist, make sure they are fully qualified and a member of a recognised body, such as the Chartered Society of Physiotherapy (CSP).

Not all physiotherapists have training in VRT, so you need to make it clear you require this type of treatment before making an appointment.

Dizziness & Balance Disorders | Temple Health

What Are Dizziness & Balance Disorders?

Dizziness is a sensation of unsteadiness or spinning. When people are dizzy, they may feel as if they’re spinning or floating. Dizziness can occur as a result of normal daily activities, such as standing up too quickly. However, more serious bouts of dizziness may be the result or symptom of a balance disorder.

Balance disorders refer to a range of conditions that cause symptoms of dizziness, including feeling like you’re floating, spinning or moving even while remaining still. While the occasional dizzy spell is normal, balance disorders cause chronic unsteadiness, which can present significant risk to overall health and lifestyle. Common balance disorders include:

• Benign paroxysmal positional vertigo (BPPV) — This is a sensation of spinning lasting seconds to minutes following quick head movements. BPPV results from loose inner ear crystals and can be readily treated.

• Middle ear effusions — Otherwise known as serous otitis media, fluid in the middle ear can cause imbalance and spinning vertigo.

• Middle ear infections — Infections of the middle ear (otitis media) can cause imbalance and spinning dizziness.

• Ménière’s Disease — This condition affects the inner ear and can cause severe dizziness, hearing loss and tinnitus. This disease occurs when fluid builds up in the inner ear, blocking signals to areas of the brain that control balance.

• Vestibular neuritis — Characterized as a sensation of continuous spinning vertigo lasting for many hours to days, this is due to a viral infection in the inner ear balance system.

• Acoustic neuroma — Also known as vestibular schwannoma, these tumors of the balance nerves can cause hearing loss, tinnitus, imbalance, and rarely can also cause spinning vertigo.

Symptoms

Balance disorder symptoms can vary dramatically in terms of frequency and severity. More occasional or intense symptoms can ultimately have a profound impact on overall health and quality of life. The most common balance disorder symptoms include:

• Dizziness and light-headedness — Feelings of unbalance, floating or spinning are common and can lead to falls or injuries.

• Blurred vision — Objects both near and far may appear fuzzy or poorly defined.

• Nausea — Feelings of sickness or vomiting often accompany other symptoms.

Treatment Options

Treating balance disorders first requires a clear diagnosis. In the event that a disorder is caused by an underlying ear problem, such as an infection, addressing the primary issue first may address dizziness or vertigo. Most often, treatment includes:

• Medication — Prescription medications, including anti-nausea medications, steroids, migraine medications, or antibiotics, can provide relief during bouts of dizziness or vertigo.

  • Commonly used over the counter medications for dizziness including meclizine, antivert, and bonine, can make balance much worse, and should be avoided for most patients with imbalance.

• Balance (vestibular) therapy — Therapy that improves the balance function is often used for the treatment of a number of balance problems.

• Behavioral change — Altering some lifestyle factors, such as sodium intake, can help minimize the impacts of balance disorders.

• Surgery — In more severe cases, doctors can stabilize the inner ear with a corrective surgery, or they may use a destructive surgical procedures to prevent the inner ear and brain from working together.

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Dizziness causes, symptoms and treatments

Illustration explaining types of dizziness.

Dizziness is one of the most frequent reasons people seek out a doctor, and it can be caused by a wide array of illnesses and conditions. If you are experiencing dizziness, a thorough medical evaluation is important.

What is dizziness?

Dizziness is one of the most common

reasons people see a doctor.

Dizziness is a disruption in your sense of balance, and it can come in many different forms—as a sensation of unsteadiness, spinning or general disorientation in relation to your surroundings. You may feel lightheaded, nauseated, woozy or like you might faint.

The body’s balance system

To understand how dizziness occurs, it helps to know how the balance organ and vestibular system work:

The balance organ

Deep within your ears, there are three tiny semicircular canals filled with fluid and crystals, known as endolymph and otoliths. The crystals float and move around in the fluid in response to your body’s angular position. Two other sac-like structures, the utricle and saccule, detect vertical and horizontal movements. Together, these structures are called your balance organ, because they help your body seamlessly detect up from down, left from right, as well as forward and backward motion.  

The vestibular system

The balance organ coordinates with your eyesight and the muscles and joints in your body to provide you with a sense of balance and orientation in your environment. This is medically known as the vestibular system.

Common dizziness symptoms

Dizziness is what happens when there is a deficit in any of the vestibular senses, or the brain centers that tie them all together. Dizziness is not a disease in itself, but a symptom of a larger problem rather than a disease. Many different conditions can cause dizziness, and it’s also a common drug side effect. Even ordinary things—like being on long, hilly car ride—can trigger dizziness in the form of motion sickness. 

There are four main categories of dizziness, according to the American Academy of Family Physicians:

• Vertigo, a false sense of motion
• Disequilibrium, feeling off-balance, unsteady or wobbly
• Presyncope, a feeling of losing consciousness or about to black out
• Lightheadedness, a vague sense of being disconnected with your surroundings

Inner ear causes of dizziness

Some of the most common causes of dizziness arise from problems in your inner ear. A disturbance in the blood circulation or fluid pressure in the inner ear can trigger dizziness and tinnitus. For example, a bad cold can swell your inner ears and lead to bouts of dizziness. You might also experience dizziness if there is pressure on the nerves responsible for delivering balance information to your brain. 

Hearing loss and dizziness: What does it mean?

There are many health conditions that can affect the inner ear and cause both dizziness and hearing loss, including severe allergies, bacterial or viral infections of the inner ear, medication side effects and some circulatory conditions. If you experience sudden dizziness and hearing loss, see a doctor right away.

Ringing in the ears and dizziness

Many disorders that affect the inner ear can potentially lead to ringing in the ears (tinnitus) and dizziness, especially Meniere’s disease.  

Benign paroxysmal positional vertigo (BPPV) typically causes dizziness but no other symptoms. 

Dizziness caused by the inner ear may feel like a whirling or spinning sensation (vertigo), unsteadiness or lightheadedness and it may be constant or intermittent. It may be aggravated by certain head motions or sudden positional changes. Although nausea and vomiting may occur, people do not typically lose consciousness as a result of inner ear dizziness. 

Other causes of dizziness

There are many other causes of dizziness that are not related to the function of the inner ear. They are generally sorted into two categories: central dizziness and visual dizziness.

Central dizziness

If the brain is not able to coordinate the inputs from the three parts of the vestibular system, there is central dizziness. Central dizziness may be caused by migraines, tumors, infections and degenerative diseases like multiple sclerosis. If you’ve ever felt the room spinning after a night of too many alcoholic drinks, than you know what central dizziness feels like.

Visual dizziness

Visual dizziness can occur if the eye muscles are imbalanced or there are errors of refraction, such as when you borrow a pair of eyeglasses from a friend with a different prescription. Other causes of visual dizziness include intermittent inability to focus the eyes, difficulty reading or intermittent blurring of vision.

Other types

Very rarely, dizzy symptoms may be caused by muscle or joint issues, such as unsteadiness due to muscular dystrophy. General health problems, such as diabetes, thyroid deficiency, vitamin deficiency, anemia and arterial blockage can cause dizziness as well.

How your body ‘compensates’

When one part of your vestibular system is afflicted, the other parts can usually compensate for the deficit. Once the system is under too much stress, though, that compensation may fall short. For example, if you must take an ototoxic drug that destroys the balance organs of the inner ear, you can still stay quite balanced as long as your eyes are open. However, when you are asked to close your eyes, you may find it quite difficult to stay standing upright. 

Evaluating dizziness

To figure out what’s causing dizziness, a medical provider must take a thorough medical history and exam. 

Drug interactions

A very common cause of dizziness that is often overlooked is the interaction of one or multiple prescription and/or over-the-counter medications. If you have recently changed or added a prescription to your daily routine, be sure to ask your physician about the possibility of dizziness as a side effect. The same is true of alcohol and caffeine–both can interact with your medications.

A very common cause of dizziness that is often overlooked is the interaction of one or multiple prescription and/or over-the-counter medications.

Tests for dizziness

There are a wide array of tests a doctor may use to evaluate dizziness, and they may be performed by a primary care doctor, a physical therapist, cardiologist or neurologist.

In some cases, especially if you also experience hearing loss, you may undergo a hearing test. The cochlea, your hearing organ, is contained within the same bony structure as your balance organ. A behavioral hearing test in a sound booth may be followed by an Auditory Brainstem Response (ABR) test. An ABR test non-invasively records brainstem responses to sound stimuli. The brain waves are collected while you rest comfortably with your eyes closed. The presence or absence of hearing loss or auditory brainstem anomalies will provide clues to the physician about the cause of your symptoms.

Another common test for balance is VNG, or videonystagmography. Usually performed by an ENT physician or an audiologist, a VNG test uses video cameras to record eye movements while a patient tracks a visual stimulus, is moved into different positions and while the ear canals are stimulated with warm and cool air or water. This test gives a broad picture of whether the underlying issue is related to the inner ear or not.

Treatments for dizziness

Appropriate treatment for dizzy symptoms will depend on the underlying cause, so it is important that you see a physician. Your doctor might prescribe something to help the dizzy symptoms temporarily, for example.

When the cause of the dizziness is determined and treated, the symptom will often go away. For BPPV, dizziness can be treated by a simple head positioning maneuver. 

Many other disorders can be treated with medication, surgery, diet, lifestyle changes or some combination of these. There are also physical therapists who specialize in vestibular rehabilitation, which is a treatment for balance disorders that gradually retrains the brain to compensate for lost sensory input from the balance system. 

Dizziness and anxiety

People with chronic episodes of dizziness may develop anxiety or even panic attacks. This is because dizziness is a very scary situation in which you may feel not just miserable (and nauseated), but helpless. 

More: Why anxiety often accompanies balance disorders, and what to do about it

When to get help

If you experience any dizziness symptoms that don’t go away, you should talk to your physician or a hearing care provider so the underlying cause can be determined and the problem remediated.

Joy Victory, managing editor, Healthy Hearing

Joy Victory has extensive experience editing consumer health information. Her training in particular has focused on how to best communicate evidence-based medical guidelines and clinical trial results to the public. She strives to make health content accurate, accessible and engaging to the public.
Read more about Joy.

What Is Ménière’s Disease? — Diagnosis and Treatment

What is Ménière’s disease?

Ménière’s disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. Ménière’s disease usually affects only one ear.

Attacks of dizziness may come on suddenly or after a short period of tinnitus or muffled hearing. Some people will have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. Some people with Ménière’s disease have vertigo so extreme that they lose their balance and fall. These episodes are called “drop attacks.”

Ménière’s disease can develop at any age, but it is more likely to happen to adults between 40 and 60 years of age. The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that approximately 615,000 individuals in the United States are currently diagnosed with Ménière’s disease and that 45,500 cases are newly diagnosed each year.

What causes the symptoms of Ménière’s disease?

The labyrinth in relation to the ear

The labyrinth is composed of the semicircular canals, the otolithic organs (i.e., utricle and saccule), and the cochlea. Inside their walls (bony labyrinth) are thin, pliable tubes and sacs (membranous labyrinth) filled with endolymph.

Credit: NIH/NIDCD

The symptoms of Ménière’s disease are caused by the buildup of fluid in the compartments of the inner ear, called the labyrinth. The labyrinth contains the organs of balance (the semicircular canals and otolithic organs) and of hearing (the cochlea). It has two sections: the bony labyrinth and the membranous labyrinth. The membranous labyrinth is filled with a fluid called endolymph that, in the balance organs, stimulates receptors as the body moves. The receptors then send signals to the brain about the body’s position and movement. In the cochlea, fluid is compressed in response to sound vibrations, which stimulates sensory cells that send signals to the brain.

In Ménière’s disease, the endolymph buildup in the labyrinth interferes with the normal balance and hearing signals between the inner ear and the brain. This abnormality causes vertigo and other symptoms of Ménière’s disease.

Why do people get Ménière’s disease?

Many theories exist about what happens to cause Ménière’s disease, but no definite answers are available. Some researchers think that Ménière’s disease is the result of constrictions in blood vessels similar to those that cause migraine headaches. Others think Ménière’s disease could be a consequence of viral infections, allergies, or autoimmune reactions. Because Ménière’s disease appears to run in families, it could also be the result of genetic variations that cause abnormalities in the volume or regulation of endolymph fluid.

How does a doctor diagnose Ménière’s disease?

Ménière’s disease is most often diagnosed and treated by an otolaryngologist (commonly called an ear, nose, and throat doctor, or ENT). However, there is no definitive test or single symptom that a doctor can use to make the diagnosis. Diagnosis is based upon your medical history and the presence of:

• Two or more episodes of vertigo lasting at least 20 minutes each
• Tinnitus
• Temporary hearing loss
• A feeling of fullness in the ear

Some doctors will perform a hearing test to establish the extent of hearing loss caused by Ménière’s disease. To rule out other diseases, a doctor also might request magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain.

How is Ménière’s disease treated?

Ménière’s disease does not have a cure yet, but your doctor might recommend some of the treatments below to help you cope with the condition.

• Medications. The most disabling symptom of an attack of Ménière’s disease is dizziness. Prescription drugs such as meclizine, diazepam, glycopyrrolate, and lorazepam can help relieve dizziness and shorten the attack.
• Salt restriction and diuretics. Limiting dietary salt and taking diuretics (water pills) help some people control dizziness by reducing the amount of fluid the body retains, which may help lower fluid volume and pressure in the inner ear.
• Other dietary and behavioral changes. Some people claim that caffeine, chocolate, and alcohol make their symptoms worse and either avoid or limit them in their diet. Not smoking also may help lessen the symptoms.
• Cognitive therapy. Cognitive therapy is a type of talk therapy that helps people focus on how they interpret and react to life experiences. Some people find that cognitive therapy helps them cope better with the unexpected nature of attacks and reduces their anxiety about future attacks.
• Injections. Injecting the antibiotic gentamicin into the middle ear helps control vertigo but significantly raises the risk of hearing loss because gentamicin can damage the microscopic hair cells in the inner ear that help us hear. Some doctors inject a corticosteroid instead, which often helps reduce dizziness and has no risk of hearing loss.
• Pressure pulse treatment. The U.S. Food and Drug Administration (FDA) recently approved a device for Ménière’s disease that fits into the outer ear and delivers intermittent air pressure pulses to the middle ear. The air pressure pulses appear to act on endolymph fluid to prevent dizziness.
  

  Location of endolymphatic sac

  Credit: NIH/NIDCD

• Surgery. Surgery may be recommended when all other treatments have failed to relieve dizziness. Some surgical procedures are performed on the endolymphatic sac to decompress it. Another possible surgery is to cut the vestibular nerve, although this occurs less frequently.
• Alternative medicine. Although scientists have studied the use of some alternative medical therapies in Ménière’s disease treatment, there is still no evidence to show the effectiveness of such therapies as acupuncture or acupressure, tai chi, or herbal supplements such as gingko biloba, niacin, or ginger root. Be sure to tell your doctor if you are using alternative therapies, since they sometimes can impact the effectiveness or safety of conventional medicines.

What is the outlook for someone with Ménière’s disease?

Scientists estimate that six out of 10 people either get better on their own or can control their vertigo with diet, drugs, or devices. However, a small group of people with Ménière’s disease will get relief only by undergoing surgery.

What research about Ménière’s disease is being done?

Insights into the biological mechanisms in the inner ear that cause Ménière’s disease will guide scientists as they develop preventive strategies and more effective treatment. The NIDCD is supporting scientific research across the country that is:

• Determining the most effective dose of gentamicin with the least amount of risk for hearing loss.
• Developing an in-ear device that uses a programmable microfluid pump (the size of a computer chip) to precisely deliver vertigo-relieving drugs to the inner ear.
• Studying the relationship between endolymph volume and inner ear function to determine how much endolymph is “too much.” Researchers are hoping to develop methods for manipulating inner ear fluids and treatments that could lower endolymph volume and reduce or eliminate dizziness.

Where can I find additional information about Ménière’ disease?

NIDCD maintains a directory of organizations that can answer questions and provide printed or electronic information on Ménière’s. Please see the list of organizations at www.nidcd.nih.gov/directory.

Use the following keywords to help you search for organizations that can answer questions and provide printed or electronic information on Ménière’s disease:

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
Email: [email protected]

NIH Publication No. 10–3404
July 2010

90,000 Otitis media ᐈ Treatment and symptoms

Description

Otitis media is the medical term for ear inflammation.

Distinguish:

• otitis media – an inflammation of the inner ear, often called labyrinthitis
• otitis media: inflammation of the middle ear, (occurs in both acute and chronic forms)
• otitis externa: inflammation of the external auditory canal or auricle

If the inflammation of the middle ear is persistent or intermittent, then we are talking about a chronic form of otitis media.In this case, in most cases, patients develop a defect in the tympanic membrane (a hole in the membrane). There are three forms of chronic otitis media: chronic purulent inflammation of the mucous membrane, chronic purulent inflammation of the mucous membrane and bone structures of the middle ear, and cholesteatoma. None of the above three forms of chronic otitis media (otitis media) can be treated without professional medical attention and surgical therapy.

Symptoms

Typical signs of acute otitis media are sudden, sharp pains, as well as a sensation of noise and pulsation in the ears, all of which can be accompanied by dizziness and hearing impairment.

With purulent inflammation of the middle ear, the tympanic membrane is often damaged and bloody-purulent fluid is released from the ear. After the perforation of the membrane, the pain in the ear may disappear.

Nonspecific symptoms of otitis media include fever (most often in young children), weakness, severe malaise, nausea and vomiting.

Symptoms for chronic otitis media

1) during the active (secretory) phase of the inflammatory process, purulent discharge of a yellowish color, often with a pungent odor, flows out through the ear canal, which can lead to infectious inflammation of the mucous membrane of the ear canal.In this case, inflammation can spread to the bones of the middle ear and provoke adhesions in connective tissues and bone structures. These phenomena, called thymanofibrosis and thymanosclerosis, cause progressive hearing loss, which is also caused by bacterial toxins from chronically inflamed middle ear mucosa. If the middle and inner ear are affected, sensorineural hearing loss may occur, i.e. combined deafness. Chronic otitis media, as a rule, after the secretory phase does not cause fever and pain.Patients mainly consult a doctor when they experience discomfort with discharge with a putrid odor from the auricle, with progressive hearing loss, dizziness, tinnitus, problems with balance, coordination of movements, or even more severe complications.

2) Symptoms of chronic suppuration of the mucous membrane and bone tissue:

Discharge from the auricle is purulent, viscous, mucous, yellow with a putrid odor. In an acute middle ear infection, pressure occurs behind the eardrum, often causing severe mastoid pain.In a number of situations, the inflammatory process with purulent otitis media passes to the bone tissue of the temporal region and the mastoid process of the temporal bone.

With an exacerbation of chronic inflammation of the middle ear, the so-called super-infection, the pain intensifies and the temperature rises. The patient has a gradual weakening of hearing until it is completely lost, tinnitus, in rare cases, dizziness, imbalance, paralysis of the facial nerve (neuritis). In a number of situations, the inflammatory process with purulent otitis media passes to the bone tissue of the temporal region and the mastoid process, and the pus accumulated above the tympanic membrane does not break through it and does not come out through the auditory tube, then the infection can penetrate through the venous vessels into the cranial cavity, which leads to severe intracranial complications such as blood poisoning (sepsis), inflammation of the venous vessels of the brain with the formation of blood clots, meningitis (infectious inflammation of the cerebral membrane), encephalitis or brain abscess

3) Symptoms of cholesteatoma:

Cholesteatoma (a tumor-like formation that develops in the middle ear cavity) has various signs depending on the stage of development of the disease: from a feeling of fullness in the ear and dull aching pain in the mastoid process, to neuralgia (shooting sharp pain) in the ear, and at the stage of exacerbation cholesteatoma is characterized by prolonged pain, fever, discharge from the auricle, progressive hearing loss with or without tinnitus, dizziness, imbalance, neurosis (paresis) of the facial nerve. The disease usually develops at a slow pace. Increasing in size, the cholesteatoma can destroy the nearby bone structures of the skull, its contents penetrate into the brain, which can cause infectious inflammation of the lining of the brain (meningitis), inflammation of the brain (encephalitis), brain abscess and other serious consequences.

Causes and risks

One of the causes of otitis media is acute respiratory disease of the nasopharynx.Acute otitis media in 80% of cases develops on the basis of a viral infection of the mucous membrane of the upper respiratory tract. The most common causative agents of infection are rhino virus, RS (respiratory syncytial) – virus, influenza virus, which rapidly multiply in the nasopharynx and Eustachian tube. In addition, in about 20% of patients, the infection is also caused by a certain type of bacteria that penetrates through the Eustachian tube into the middle ear, such as, for example, streptococci (Streptococcus pneumoniae) or the bacillus influenza (Haemophilus influenza).

This process is observed mainly in patients with frequent cases of chronic inflammation of the nasal mucosa or paranasal sinuses.

Possible causes of chronic otitis media include allergic diseases of the upper respiratory tract or (less commonly) swelling in the nasopharynx. A special form of chronic otitis media, cholesteatoma, can be congenital (genuines Cholesteatom) or result from a fracture of the longitudinal temporal bone (post-traumatic cholesteatoma).

Primary acquired cholesteatoma arises as a result of a retracted saccular cavity (pocket) of the tympanic membrane and negative pressure within the middle ear. As soon as the retraction becomes too deep, and the keratin is no longer able to be removed from the fold, its remnants begin to accumulate in it. Secondary acquired cholesteatoma occurs due to ingrowth of squamous epithelial cells from the edges of a rupture in the tympanic membrane. Such a rupture most often occurs as a result of an infectious inflammatory process in the middle ear.

Examination and diagnosis

In order to identify acute inflammation of the middle ear, to establish a diagnosis of acute otitis media, the otolaryngologist examines the eardrum, nasopharynx, nasal cavity and paranasal sinuses. In some cases, it is necessary to check the patient’s balance and coordination of movements in order to timely identify possible consequences of the disease, for example, labyrinthitis with toxic damage to the inner ear. In this case, such research methods are used as tympanometry, threshold audiometry, sound audiometry.

Diagnostics also includes hearing tests. Auricle discharge is often analyzed. In case of suspicion of complications, for example, mastoiditis (inflammation of the mastoid process of the temporal bone) or other side effects, an X-ray examination is performed. With the help of an X-ray image, the results of a computed tomography of the temporal bone or cranium, it is possible to determine the expediency of surgical intervention in a timely manner.

Treatment

Treatment of otitis media is mainly symptomatic.This means that it is aimed at eliminating the symptoms of the disease, and not the cause that caused the disease. This is due to the fact that otitis media is caused by various viruses and bacteria that are resistant to many antibiotics, so not every antibiotic provides an effective treatment result.

At the initial stage of the disease, it is recommended to use decongestant nasal sprays. Additionally, it is prescribed to take anti-inflammatory, antipyretic and pain relievers of natural origin, for example, tablets, which include Bromelain.Tablets with the active ingredient Diclofenac also have anti-inflammatory, decongestant and analgesic effects. In case of intolerance to Diclofenac, it can be replaced with Ibuprofen, if there are no contraindications to taking it. Children are advised, after consulting a doctor, to take paracetamol as an analgesic and antipyretic agent. Treatment of otitis media also includes instilling anesthetic drops into the ear canal, but only as directed by a doctor. Self-medication is unacceptable, since the symptoms will be mild and make it difficult to diagnose the disease.

Antibiotic treatment is prescribed by a doctor in order to prevent serious complications after otitis media and to reduce the risk of the consequences of otitis media. At the same time, it is important to strictly follow all instructions regarding the frequency and duration of antibiotic use.

If the tympanic membrane does not burst during inflammation and the purulent contents accumulated above it does not get out, the doctor may make a small incision in the anterior lower part of the membrane so that pus can flow out through this opening.This procedure is performed for adults under local anesthesia and for children under general anesthesia. Due to the fact that the incision in the eardrum within a few days can heal on its own, the doctor often inserts a small plastic, titanium or gold tube into it to facilitate the outflow of purulent contents, ventilate the middle ear and ensure normal air pressure in it. If such a drainage tube does not come off by itself within 6-12 months due to the fact that the hole is clogged with sulfur or squeezed by a thickened scar on the eardrum, then it is removed promptly.In this case, the tympanic membrane is restored in most cases by itself.

If otitis media often occurs in children at an early age, then they are recommended to remove enlarged from birth or chronically inflamed tonsils, adenoids, children’s “polyps”. In adolescent children with frequent or chronic inflammation of the nasal mucosa and paranasal sinuses, accompanied by otitis media, surgery is a necessary treatment. Here we are talking about the so-called sanitation of the nasopharynx, nose and paranasal sinuses. None of the above forms of chronic otitis media can be treated only surgically – it is necessary only when conservative treatment does not give the desired result.

Treatment course and prognosis

As a rule, with timely diagnosis and proper treatment, otitis media proceeds without consequences and is completely curable. About 80% of patients get rid of symptoms within 2-7 days from the onset of the disease.

However, chronic otitis media sometimes causes complications, the most common of which is mastoiditis (inflammation of the mastoid bone of the temporal bone).The mastoid is part of the skull bone, is located near the middle ear and is also filled with air. With mastoiditis, bone tissue is often affected and inflammation can spread to the lining of the brain or the brain.

Frequent otitis media in childhood leads to hearing loss and a delay in the development of speech in the child. One of the complications of the disease can be inflammation of the inner ear (labyrinthitis).

Notes

Acute otitis media sometimes occurs on the basis of certain infectious diseases, for example, scarlet fever or measles, and manifests itself with symptoms typical for it.

Acute purulent otitis media and brain abscess

O.V. Stratieva (From lectures for doctors)

Otogenic intracranial complications result from the penetration of infection from the ear cavities into the brain cavity. The number of patients with otogenic intracranial complications in relation to the total number of patients with diseases of the middle and inner ear ranges from 1 to 15% and tends to decrease. However, the problem of otogenic intracranial complications remains relevant.Over the past three years, we have operated on more than 30 patients with otogenic intracranial complications. The most common: thrombosis of the sigmoid and transverse sinuses, epidural abscess of the middle and posterior cranial fossa, perisinous abscess, otogenic meningitis, abscess of the temporal lobe of the brain, less often cerebellar abscess was observed. The features of the modern clinical picture of otogenic intracranial complications are characterized by a case from our practice.

Case from practice.

G., 68 years old, was admitted to the ENT center with complaints of headache, dizziness, nausea, weakness in the left leg, fever up to 37.5 ˚, malaise.

It is known that the patient was ill for a month when suddenly there were pains in the right ear and purulent discharge from the ear. She was treated independently, with dry heat. After two weeks, the condition improved. Ear pain and suppuration stopped. However, inadequacy, lethargy and headache appeared in the patient’s behavior, which forced the patient’s relatives to seek advice from an otolaryngologist.

On admission: the patient is conscious. There is no pain behind the ear.The eardrum is dull, no perforation, no pus. The neurologist found a deviation to the left with a finger – nasal test, flattening of the left nasolabial fold. In the fundus – atherosclerosis of the retinal vessels.

On a computed tomogram of the brain on the right in the temporoparietal region, extensive rounded formations with a capsule up to 2.1 cm in diameter, density from 19 to 24 H units, with contrast – up to 65 H units are determined. Additionally, magnetic resonance imaging was performed (Fig. 1 , 2), where a purulent process was established in the right temporal pyramid with a bifocal brain abscess and thrombosis of the cavernous sinus.

Otolaryngologists and neurosurgeons performed two operations: craniotomy with decompression of the brain, opening and removal of the temporal lobe abscess, and extended mastoidectomy with exposure of the cranial fossa and cerebral sinuses. During the operation, osteomyelitis of the temporal bone pyramid, the wall of the ear canal and the tympanic cavity was found. For four days the patient was in intensive care, then 14 days underwent rehabilitation at the ENT center, and after that she was discharged home in a satisfactory condition.

SUMMARY

Today, in comparison with the period from 1946 to 1980. XX century, the number of intracranial complications due to otitis media has significantly decreased. The use of powerful antibiotics has significantly improved the quality of treatment, but at the same time has made the diagnosis more difficult. If earlier manifest forms with vivid symptoms prevailed, today, almost all otogenic intracranial complications develop secretly. Also, in recent years, the complexity of diagnosis is due to a combination of several forms of intracranial complications at once.

Dizziness and tinnitus

S.Ya. Kosyakov, GZPiskunov

Dizziness

Introduction
Dizziness is a general term characterizing a large number of symptoms. In general, it means a pathological sensation of movement, it can also mean imbalance, light-headedness, darkening of the eyes, disorientation, weakness, and other sensations. Symptoms can vary in intensity from mild and short in duration to severe attacks of rotation accompanied by nausea and vomiting.

For a more precise definition of symptoms, the following definitions are used:
Dizziness: is a general term characterizing the symptoms of imbalance and stability.
Imbalance: Difficulty maintaining balance, especially while standing and walking.
Light-headedness: Feeling of “shutdown”, similar to the sensation that occurs when holding the breath for a long time.
Systemic dizziness: sensation of rotation, spinning, twisting of surrounding objects.
The ability to maintain balance is the result of the complex interaction of various organs and systems. The brain is the main center for processing all information about balance coming from the senses to the muscles that maintain balance.
Information in the form of nerve impulses comes from the main systems: visual, vestibular, proprioceptive and tactile (joints and feet). Visual information is the most important for the brain and signals movement in relation to surrounding objects.
Anatomy
There are two components of hearing: mechanical and electrical (neural). The mechanical component ensures the delivery of a sound wave through the external auditory canal, movement of the eardrum and three auditory ossicles in the middle ear. The inner ear is represented by a cochlea, which consists of two halves connected to each other and filled with fluid. The cochlea is responsible for the electrical component of hearing and converts a mechanical signal into an electrical signal, which in turn goes to the brain.
The other part of the inner ear is responsible for balance and the vestibular system. Three semicircular canals are located in mutually perpendicular planes. Depending on the direction of movement of the head, fluid moves in the channels, the resulting electrical impulse is transmitted to the brain through the vestibular nerve, transmitting information about the direction of movement. The inner ear fluid is refreshed daily. The source of its origin is the cerebrospinal fluid, absorption occurs in the endolymphatic sac.In Meniere’s disease, the absorption capacity of the endolymphatic sac deteriorates. Increased pressure in the inner ear leads to dizziness and hearing loss.
The facial nerve exists in close relationship with the ear. The facial nerve moves the muscles of the face and provides the tip of the tongue for taste recognition. When it is damaged, the eye closes poorly, liquid pours out from the corner of the mouth, it is impossible to carry out mimic movements on the affected side.

Balance function
Balance function is provided by the interaction in the brain of nerve impulses coming from the inner ear, cervical muscles, muscles and joints of the lower extremities.Disturbances in any of these systems can lead to a subjective feeling of dizziness and instability. General dysfunctions of the body (for example, low or high blood pressure, myopia, and many others) can lead to dizziness, affecting the coordination of impulses in the brain.

The brain’s response to distorted or incoherent impulses can lead to false sensations of movement (dizziness), which in turn leads to unsteadiness in gait and falls.
Dizziness is often accompanied by cold sweats, nausea and vomiting.
Visual signals and signals from muscles and joints (tactile and proprioceptive) entering the brain warn us that we are moving on the right path or that our head is tilted. The brain interprets this information along with information from the vestibular system and gives the appropriate command to the muscles to maintain balance. Dizziness occurs when sensory information is distorted.Some people feel dizzy, for example, in a high place. This is partly due to the inability to focus on nearby objects. Standing on the ground, a person can sway weakly. A person maintains balance, identifies his body position relative to something. When in a high place, it is difficult for a person to correlate the position of his body relative to objects in the distance and, accordingly, it is more difficult to maintain balance. As a result, anxiety, fear, dizziness may occur, which sometimes makes a person sit up.
It is believed that motion sickness, a disorder that occurs when rolling, in a car, or flying, occurs when the brain receives conflicting sensory information about the movement and position of the body. For example, when reading while driving in a car, the inner ear senses the movement of the vehicle, but the gaze is fixed on a stationary book that does not move. As a result, sensory conflict can lead to typical symptoms of motion sickness, dizziness, nausea, and vomiting.
Another form of vertigo occurs with repeated rotation and sudden stop.Rotation causes the endolymph to move. The movement of the endolymph causes impulses, which in turn tell the brain that we are moving, but other sensory systems report that we have stopped, so the patient feels dizzy.

Causes of vertigo
Vertigo can be categorized according to the part of the vestibular system that is not working properly. Disorders can occur at the level of the inner ear, brain, eyes and extremities (muscles of the back, neck, legs and joints reacting to maintain our position).
Vertigo due to inner ear
Part of the inner ear (cochlea) is used for hearing, the other part is used for balance (labyrinth). If there are abnormalities in the labyrinth or in the nerve that connects it to the brain, then this leads to dizziness. Various types of disorders in the inner ear can lead to dizziness, including Meniere’s disease, labyrinthitis, positional vertigo, vestibular neuronitis, and nerve tumors. These disorders usually cause imbalance, spinning sensation, and nausea.Also, these phenomena can be accompanied by ear noise and hearing loss on the corresponding side.
Central vertigo
Central vertigo is usually caused by disturbances in the region of the brain responsible for balance. Symptoms may include light-headedness, disorientation, unsteadiness, and sometimes fainting. Central vertigo can be caused by low blood sugar, low blood pressure, stroke, multiple sclerosis, migraines, head injuries, tumors, and age-related changes.Treatment for this type of vertigo is usually associated with the elimination of problems leading to disruption of the brain.
Musculo-articular vertigo
This type of vertigo is rare. If there are diseases of muscles, joints or the sensitivity of the lower extremities is impaired, then difficulties arise in the reaction of the body to movement and in maintaining an upright position. Musculoskeletal vertigo can be caused by: atrophic changes in the muscles (muscular dystrophy), severe diabetes, arthritis, joint implantation, and trauma.Symptoms: Generally instability and imbalance.
Dizziness
Eye muscle instability and poor vision can impair balance. The brain relies on visual information to maintain balance. Motion sickness in a car or at sea are examples of visual dizziness because the eyes are constantly fixed on a moving object and “confuse” the vestibular part of the brain. This leads to dizziness, nausea, and vomiting.
Dizziness is not a fatal condition and may resolve with treatment, but balance disorders may remain.

Diagnosis of dizziness
Dizziness can be caused by various disorders in the body. Based on the history of the disease and examination data, the doctor chooses the required scope of examination to obtain a more complete picture of the disease. The usual set of examinations includes a study of hearing and vestibular function, computed tomography and nuclear magnetic resonance, blood tests, ultrasound examination.
The most commonly used test for vertigo is electronystagmography (ENG).This test measures inner ear endurance and eye coordination. The method involves observing eye movements while blowing cold and warm air to the external auditory canal. This usually produces a brief feeling of dizziness. It is important not to take any medications before testing that could interfere with the test results (eg Valium, alcohol, etc.). When prescribing such an examination, it is necessary to find out from the doctor the effect of the drugs taken on the test results.
Transcranial Doppler is another test specific for the examination of vertigo of vascular origin. It is a safe, quick way to see disturbances in blood flow in the areas of the brain responsible for balance.
Computed tomography (CT) of the temporal bones and, in some cases, magnetic resonance imaging (MRI) is also possible.
The purpose of these examinations is to achieve confidence in the absence of life-threatening pathology and to determine the exact location of the violation.This is the basis for effective treatment. The scope of the examination is determined by the doctor in each specific case. Several tests are needed to diagnose the cause. Perseverance and understanding is necessary for both the doctor and the patient, which is also the basis for effective treatment.

Most common types of vertigo
Benign paroxysmal positional vertigo (BPPV)
BPPV is the most common type of vertigo.In this disease, dizziness occurs only when the position of the head changes (as a rule, when turning in bed, tilting the head backward or forward). This type of vertigo is caused by microcrystals that float in the inner ear fluid and cause a spinning sensation. The most common cause of BPPV is head injury or viral infections, but sometimes it starts without any apparent cause.
Treatment for BPPV consists of specific exercises to return the crystals to a place where they will not cause dizziness.When they are at rest, in a certain position, for 48 hours, they are often fixed in place. Exercise can reduce symptoms. If these actions are ineffective, then surgical treatment (for example, occlusion of the posterior semicircular canal) may be necessary.

Vestibular neuronitis
Neuronitis (nerve inflammation) usually occurs with a viral lesion and can affect the balance centers or the vestibular nerve. When this happens, the centers of equilibrium in the brain are overstimulated, resulting in significant imbalance and systemic dizziness.Fortunately, vestibular neuronitis usually subsides over time and does not recur. Drugs such as, for example, Betaserc help in the initial stage and reduce the manifestation of the main symptoms, later vestibular rehabilitation exercises can speed up the healing process. In some cases of persistent course, surgical treatment is recommended.
Meniere’s disease (Endolymphatic hydrops)
Meniere’s disease is a consequence of disorders in the inner ear due to an increase in pressure in the endolymphatic space.This is usually due to an increased concentration of sodium in the fluids of the inner ear. In addition to imbalance that lasts for hours, patients may experience hearing fluctuations (fluctuations), tinnitus, and a feeling of congestion in the affected ear. Sometimes both ears are affected.
The full cause of this violation is not fully understood. Sometimes seizures can be caused by excessive salt intake, excitement, changes in the weather, and other reasons.
Treatment usually includes restriction of salt intake and the use of diuretics, fluid restriction, the use of sedative drugs and some others that have a suppressive effect on the vestibular apparatus.Betaserc is the only drug created for long-term treatment of vertigo. Treatment helps to reduce the severity of seizures, but a complete cure for the disease cannot be achieved. Vestibular rehabilitation exercises can speed up the recovery process and increase the patient’s resistance to vestibular disturbances. All drug prescriptions should be carried out only by a doctor.
Surgical treatments are available for severe cases of Meniere’s disease. The list of these methods is long and more often they are destructive for structures responsible for balance.

Vascular vertigo
The correct functioning of the equilibrium system requires not only the flow of information into the inner ear, but also the appropriate transmission of impulses along the nerves to the brain. If not enough blood is supplied to the areas of the brain responsible for balance, even for a short time, then dizziness may occur.
The causes of vascular vertigo are different. The phenomena of osteochondrosis in the cervical spine can lead to compression of the arteries leading to the brain, atherosclerotic plaques can narrow the arteries, also causing a decrease in blood flow.Often, blood pressure in the vessels to the brain can be temporarily reduced by standing up suddenly, especially in older patients receiving blood pressure lowering medications. Special examinations such as MRI or Doppler ultrasonography help diagnose these conditions.
Another rather rare cause of vertigo is Perilymphatic fistula
The inner ear is a fluid-filled space in the temporal bone. If there is an outflow of fluid from the structures of the inner ear, then hearing loss may occur, which may be more or less, and dizziness.
Most often, the leakage of fluid occurs through the membranes of the windows of the inner ear, which can occur after exercise or injury. In some cases, there are congenital disorders that characterize an enlarged connection between the inner ear and the brain (“enlarged vestibular aqueduct”). Sometimes this can be seen with a special X-ray examination – computed tomography. Sometimes the ruptured membrane heals on its own, sometimes minor surgery is required.Perilymphatic fistula, or as it is also called, the labyrinth fistula can result from chronic inflammation of the middle ear, especially with cholesteatoma. Cholesteatoma is a compacted skin scales.In the presence of a hole in the eardrum, the skin grows into the middle ear cavity, and its waste products, like the formation of a pearl, form a cholesteatoma lump, which presses on the walls of the middle ear cavities and destroys the bone, in particular, the semicircular canal. Therefore, the treatment of chronic otitis media is very important, and when the hole is localized in the upper part of the tympanic membrane (epitympanitis), it must necessarily be surgical, i.e.to. most often in these cases, cholesteatoma is found.

Tumors
Rarely, tumors can cause dizziness. Most of the tumors are benign. Acoustic neuroma is a benign tumor of the vestibular nerve. Having a neuroma can lead to instability, hearing loss, and noise. The most effective method of treatment is surgery.

Treatment of vertigo
All questions regarding the treatment of vertigo and, in particular, taking medications should be discussed with your doctor. Treatment in each case is selected individually and depends on age, severity of dizziness, concomitant diseases and many other factors.

Tinnitus
Tinnitus is a very common symptom. The noise can be constant or intermittent, of varying severity and frequency. Noise can be subjective (heard only by the patient) or objective (heard by others), combined or not with hearing loss.
Murmur is a symptom, not a disease, and can occur in a variety of conditions, such as pain in the arm or leg, as a symptom of various diseases.Noise occurs when the auditory nerve is irritated for various reasons.
Noise may or may not be accompanied by hearing impairment. Hearing is measured in decibels (dB). A hearing level of 0 to 25 dB is considered normal for the perception of spoken language.
Hearing mechanisms
To understand the possible causes of noise in the ear, it is necessary to have some understanding of the mechanisms of hearing. The mechanism of auditory perception is provided by five main components: the outer ear, the middle ear, the inner ear, the pathways, and the brain.
Outer ear
The outer ear consists of the auricle and the external auditory canal. These structures collect sound waves and transmit them to the eardrum.
Middle ear
The middle ear is located between the eardrum and the inner ear. This space contains three ossicles: the malleus, incus, and stirrup. The vibrations of the eardrum are transmitted through the ossicles to the inner ear fluid.
The middle ear is lined with mucous membranes identical to the nose and contains mucous glands and blood vessels. The tympanic cavity is connected to the posterior parts of the nose using the Eustachian tube.
The Eustachian tube maintains equal pressure between the middle ear and the outside atmosphere. The feeling of a click or congestion when changing altitude is a demonstration of the ventilatory function of the Eustachian tube.
Inner ear
The inner ear is located in a dense bone capsule and contains fluids and auditory cells.The cells are covered with a delicate membrane with microscopic blood vessels. In the inner ear, fluid vibrations resulting from movements of the stirrup are converted into electrical impulses in the nerve. Electrical impulses originating in the inner ear are transmitted to the brain via the auditory nerve. The auditory nerve that goes to the brain is located in a small bone canal along with the vestibular and facial nerves.
Brain The auditory nerve, reaching the brain, is divided into many internal connections. In the brain, nerve impulses are recognized as recognizable sounds.

Ear murmur
Most ear murmurs are heard only by patients – this is a subjective murmur. The noise that the patient hears himself, and anyone else is called objective.
Objective murmur may result from muscle spasms in the middle ear or auditory tube, or from abnormalities in the blood vessels surrounding the ear.
Muscular ear murmur
The murmur may result from muscle spasm attached to one of the ossicles or from muscle spasm attached to the auditory tube.
There are two muscles in the middle ear: the stapes, which is attached to the stapes, and the muscle stretching the eardrum, attached to the hammer. Usually, these muscles contract rapidly in response to loud noise or fear.
Sometimes one or two of these muscles begin to contract rhythmically for no apparent reason. These contractions can cause repetitive noise in the ear. The annoying clicking will usually go away on its own. Muscular ear noise as a result of spasm of various muscles of the pharynx is quite rare, but sometimes it can be.If muscle spasm is of a prolonged nature, then drug treatment (muscle relaxants) or surgical treatment (intersection of spasmodic muscles) is used.

Vascular ear murmur
There are two large blood vessels closely associated with the middle and outer ear: the jugular vein and the carotid artery. These are large blood vessels that supply and drain blood to the brain. It is not normal to hear your own heartbeat or the noise of blood passing through these large vessels. Sometimes this phenomenon can occur with high fever, middle ear infections, after intense physical activity.The circulation noise in these situations is temporary and not audible to others. Sometimes the noise of blood circulation is heard by others. This can be due to the thickening of the blood vessel wall, bending or narrowing in the vessel. Further examination is necessary to identify the cause and the choice of treatment for this pathology.

Ear noise due to the external ear
Closure of the external auditory canal with gray, foreign body, edema lead to hearing loss and pressure on the eardrum.This often results in a pulsating noise.
Tinnitus due to middle ear
Dysfunction of the middle ear may result from an allergic reaction, infection, trauma, scarring, and limitation of the ossicles. These impairments often lead to hearing impairment and tinnitus. However, there is no direct relationship between the degree of hearing loss and the intensity of noise.
Tinnitus due to the inner ear
Any condition that imbalances the fluid pressure in the inner ear can lead to tinnitus.This can be the result of an allergic reaction, infection, circulatory disorders, which lead not only to changes in the fluids of the labyrinth, but also in the membrane structures of the inner ear.
Ear noise due to damage to the pathways
Pathways are the most delicate structures of the mechanism responsible for hearing. Hair cells convert fluid vibrations into nerve impulses. The slightest edema and disturbance of interference in the hair cells, regardless of the cause, lead to dysfunction and irritation.This can occur for various reasons: allergic reactions, infections, edema, systemic diseases, both acute and chronic, toxic effects, sudden loud sounds and in sensitive subjects, trauma, exposure to medications, minute changes in blood supply and changes in nutrition.
Pressure changes can cause swelling both outside and inside the nerve as it travels through the bony tunnel to the brain. In these cases, the tinnitus occurs on one side. Becausethe bone tunnel cannot stretch, then due to compression, not only the auditory and vestibular functions suffer, but also the facial nerve.
A rupture or spasm of a small vessel anywhere in the ear canal causes compression and impaired circulation. Accordingly, under such conditions, sudden noise with complete or partial loss of hearing function may occur. If the thrombus is small, then it can dissolve with minimal consequences.
Ear noise of the brain nature
Any disorders as a result of edema, pressure or circulatory disorders in hypertension, atherosclerosis, as a result of the consequences of trauma, may involve one or more complexes of pathways at the entrance and end of them in the brain.In such situations, symptoms are usually localized on one side, in addition, the development of symptoms and signs can prompt the doctor about the location and extent of the lesion.
Tinnitus accompanying hearing loss
Tinnitus may or may not be associated with hearing impairment. When tinnitus and hearing loss coexist, the intensity of the tinnitus is not indicative of further development of hearing loss. Many patients with ear noise are afraid of the progression of hearing loss.However, these are often unrelated things.
All questions concerning the treatment of tinnitus should be discussed with your doctor.
Thus, the treatment of vertigo and tinnitus is a complex task, which can be successfully solved only by the joint efforts of the doctor and the patient. High-quality hearing diagnostics plays a very important role in such treatment. Consistency in identifying the causes of these conditions, in treatment and rehabilitation is an essential condition for achieving success.

Labyrinthitis: disease treatment | Clinic Rassvet

Fast passage

Labyrinthitis is an inflammation of the membranes and nerve structures of the inner ear that can be caused by various viruses, bacteria and their toxins, as well as trauma.

Among all ear diseases, labyrinthitis occurs in 3.8-4.2% of patients.

Anatomy

The inner ear (labyrinth) is located in the thickness of the pyramid of the temporal bone and consists of a system of bony cavities (bone labyrinth) and the membranous formation included in them (membranous labyrinth).

The labyrinth consists of three parts: the cochlea – the auditory part, the vestibule and the semicircular canals – the vestibular part.

Etiology

The source of infection is most often a focus of inflammation in the cavities of the middle ear or skull, located in the immediate vicinity of the labyrinth, but the disease can also occur as a result of hematogenous (through the vessels and lymphogenous pathways) spread of infection.

Middle ear inflammation is the most common cause of labyrinthitis.Infection from the labyrinth can spread to the meninges or brain matter. As a result, various intracranial complications (meningitis, subdural abscess, abscesses of the brain and cerebellum) may occur.

By the prevalence of the inflammatory process, limited labyrinthitis is distinguished, when the inflammatory process is noted in one of the parts of the labyrinth, and diffuse, capturing the entire labyrinth.

According to the severity of clinical symptoms – acute and chronic.

By the nature of inflammation, labyrinthitis are divided into aseptic, serous, purulent and necrotic.

Due to the widespread use of antibiotics, purulent and necrotizing labyrinthitis is now less common, there is a tendency to an increase in its local, limited forms.

Symptoms

In typical cases, acute labyrinthitis is manifested by the so-called labyrinth attack – suddenly developing severe systemic dizziness combined with nausea and vomiting, ataxia (motor disorder), high-frequency noise in the ear and hearing loss, up to deafness.The patient is usually at rest on the side of the healthy ear, the severity of dizziness is such that he cannot raise his head, turn it to the side – the slightest movement increases nausea and causes vomiting, profuse sweating, hyperemia or, conversely, pallor of the facial skin, bradycardia is observed. It seems to the patient that objects are moving in a circle – now in one direction, then in the other, there is a feeling that he is “falling” out of bed.

With serous labyrinthitis, symptoms persist for 2-3 weeks and gradually subside.With purulent – after the acute period subsides, the disease can become protracted.

When meningococcal infection, as a rule, both labyrinths are affected, which is accompanied by vestibular disorders, more often imbalance. Tuberculous labyrinthitis is characterized by a chronic latent course, progressive dysfunction of the labyrinth against the background of moderately pronounced manifestations of the general infectious process (low-grade fever, weakness, polymyalgia (muscle pain), etc.). The clinical picture of syphilitic labyrinthitis is diverse. Typical cases are characterized by fluctuating (transient) episodes of hearing loss and dizziness.

Diagnostics

The diagnosis is based on a carefully collected anamnesis. At the reception, the doctor conducts an otoscopy (examination of the outer ear and eardrum), an assessment of vestibular function, audiometry (a hearing test). For patients with suspected labyrinthitis, computed tomography of the temporal bones or magnetic resonance imaging of the brain is recommended to identify the site of infection.

In the study of hearing, hearing loss of a mixed type is revealed, more often with a predominance of the sensorineural component.

General clinical and biochemical blood tests reveal characteristic signs of inflammation (leuko- and lymphocytosis, accelerated ESR, increased concentration of C-reactive protein).

Differential Diagnostics

Most often, labyrinthitis is differentiated (distinguished) with cerebellar abscess and arachnoiditis (inflammation of the arachnoid membrane of the brain or spinal cord), as well as with non-inflammatory diseases manifested by dizziness – benign paroxysmal positional vertigo (BPPV), Meniere’s disease.

Treatment of labyrinthitis

Conservative treatment includes the use of specific therapy, for example, antibiotics, taking into account the sensitivity to the pathogen and the ability to penetrate the hematolabyrinthine barrier. Non-steroidal anti-inflammatory drugs, antihistamines can be prescribed, vestibulolytics (dimensionhydrinate) are used during the labyrinth attack.

Surgical treatment of otogenic labyrinthitis consists in sanitation of a purulent focus from the middle ear cavities.Sanitizing ear surgery is performed for any form of labyrinthitis.

Some patients are subsequently recommended vestibular and auditory rehabilitation (hearing aids, cochlear implantation).

How is labyrinthitis treated at the Rassvet clinic?

For a patient with suspected labyrinthitis, we recommend hospitalization in the ENT department of the clinics with which we cooperate. Including for surgical treatment, if indicated.

Effective and timely treatment of acute and chronic inflammatory diseases of the middle ear is the main direction of prevention of labyrinthitis and, as a consequence, the development of intracranial complications.

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90,000 Vestibular disorders – dizziness and imbalance

The vestibular system originates in the inner ear – in the vestibule and semicircular canals (these structures are also called the vestibular apparatus), the rest of its superior structures are located in various parts of the brain.

In this regard, vestibular disorders associated with diseases of the inner ear and vestibular nerve are distinguished (they are mainly treated by otorhinolaryngologists), and vestibular disorders associated with damage to parts of the vestibular analyzer located in the brain (they are dealt with by neurologists ).

Dizziness and imbalance due to diseases of the inner ear and vestibular nerve:

Meniere’s disease (synonym – chronic remitting labyrinthopathy) – a chronic disease caused by a recurrent increase in intra-labyrinth pressure (or hydrops labyrinth). The reason for hydrops is the excessive production of the endolymph intra-labyrinth fluid, a violation of its circulation and reverse absorption. It proceeds in the form of repeated attacks of dizziness with a feeling of movement of the surrounding objects or the person himself (in the English-language literature – “vertigo”), nausea and hearing impairment (usually on one side).Attacks can last from several hours to a day.

Acute labyrinthopathy of vascular genesis – sudden hearing loss in one ear with severe dizziness with a sensation of movement of surrounding objects (vertigo), most often caused by an acutely frolicking circulatory disorder in the inner ear.

Chronic purulent otitis media – a chronic inflammatory process in the tympanic cavity, characterized by the presence of perforation of the tympanic membrane, suppuration and hearing loss.The inflammatory process can be accompanied not only by hearing loss, but also by dizziness and imbalance. In the absence of treatment, there is a risk of developing labyrinthitis (acute inflammation in the inner ear) and intracranial complications.

Perilymphatic fistula – pathological communication between the inner and middle ear due to damage to the membranes located between them, accompanied by the outflow of fluid from the inner ear, perilymph, into the middle ear. It occurs as a result of ear trauma, barotrauma (with a drop in atmospheric pressure), etc.reasons. It is accompanied by dizziness and unilateral hearing loss.

Benign paroxysmal positional vertigo, BPPV (synonym – otolithiasis) – a condition in which fragments of the otolith membrane (calcium carbonate crystals), usually located on the eve of the labyrinth, due to trauma, age-related changes, and other reasons leave their location and end up in one of the semicircular canals (or in several semicircular canals). The displacement of the detached otoliths arising at certain head positions and inclinations causes attacks of short-term dizziness.Depending on the localization of the detached otoliths, cupulo and canalolithiasis are distinguished.

Vestibular neuronitis – acute inflammation of the vestibular portion of the vestibular-cochlear nerve and its vestibular ganglion, most likely of viral herpetic etiology. During the first 3-7 days, it manifests itself as an acute vestibular syndrome – severe dizziness with a sensation of rotation of surrounding objects (vertigo), imbalance, nausea, followed by the subsiding of symptoms within 2-4 weeks.

Acoustic neuroma (synonyms – neuroma of the statoacoustic nerve, vestibular schwannoma) – benign formation of the statoacoustic nerve, causing unilateral hearing loss, often noise in the ear, dizziness and imbalance. In the absence of surgical treatment, the growth of neuromas causes compression of various structures in the brain and can lead to the development of life-threatening conditions.

Motion sickness (synonyms – motion sickness, kinetosis) – a complex of symptoms in the form of nausea, increased salivation, malaise, provoked in some people by driving in transport (in a bus, car, plane, at sea), riding on attractions.It is caused by the development of vestibular-vegetative symptoms, primarily in the form of nausea, in response to irritation of the vestibular apparatus in the above conditions.

Dizziness and imbalance caused by diseases of the brain and central nervous system:

• Acute and chronic disorders of cerebral circulation.
• Post-traumatic brain injury.
• Consequences of previous intoxications and infections of the central nervous system (meningitis, encephalitis).
• Demyelinating diseases of the central nervous system (multiple sclerosis, etc.).
• Brain tumors.
• Osteochondrosis of the cervical spine.

Diagnostics of vestibular disorders

The diagnosis of vestibular disorders should begin with a consultation with an otorhinolaryngologist and a special vestibular examination.

The algorithm for examining patients with dizziness and imbalance is as follows:

1. Consultation of a vestibulologist-otorhinolaryngologist (includes traditional otoneurological examination, hearing examination, examination of ENT organs),
2. conducting video oculography (synonym – vidionystagmography) or electronystagmography.With the help of video oculography, eye movements are recorded in tests for the study of spontaneous nystagmus, “cervical” nystagmus, positional nystagmus (in the Dix-Hallpike test, etc.), positional nystagmus, in the bithermal caloric test. The listed methods are necessary for the detection of vestibular dysfunction and for the differential diagnosis between central and peripheral vestibular disorders.
3. If necessary, a consultation with a neurologist is appointed to rule out diseases of the central nervous system that cause dizziness.
4. In some cases, it is necessary to consult a physician and an ophthalmologist.
5. Additional research methods may also be prescribed – magnetic resonance imaging of the brain, computed tomography of the brain.

Otitis media in a child – causes, symptoms, diagnosis and treatment of otitis media in children in Moscow at the children’s clinic “SM-Doctor”

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Contents:
Description of the disease
Symptoms
Causes
Diagnosis
Treatment
Prevention
Otitis media is an infectious and inflammatory process localized in the outer, middle or inner ear of a child.The diagnosis and treatment of this disease is carried out by an otolaryngologist.

Description of the disease

Otitis media refers to an inflammatory lesion of the ear caused by various infectious pathogens – bacteria, viruses or fungi. The disease is widespread in childhood. According to statistics, before the onset of the school period, pathology is diagnosed in 90% of children. Boys and girls under 5 years of age are especially susceptible to the disease (due to the physiological characteristics of the structure of the ear and imperfect immunity).

There are 3 forms of otitis media, depending on the site of inflammation: external, middle and internal. With otitis externa, the inflammatory process occurs in the auricle and the external auditory canal. The location of otitis media is the middle ear area; internal otitis media, respectively – the inner ear. According to the type of discharge formed, otitis media is divided into serous and purulent.

Any form of the disease requires qualified medical care. Without proper treatment, the disease can cause serious complications and lead to sepsis, meningitis, encephalitis, inflammation of the facial nerve, hearing loss or complete hearing loss.

Symptoms of otitis media

The clinical picture of otitis media directly depends on the form of the course, however, symptoms common to all varieties can be distinguished:

• pain syndrome in the ear;
• the presence of sulfuric or purulent discharge;
• hearing loss;
• a feeling of ear congestion;
• irritability and tearfulness;
• general weakness.

Otitis externa can be suspected by swelling and redness of the skin of the external auditory canal, peeling of the skin, and mucous or purulent discharge from the ear.At the beginning of the disease, the child suffers from severe pain, which, after a while, passes and is replaced by a feeling of congestion. As a rule, with the external form of otitis media, the quality of hearing does not decrease.

Symptoms of otitis media are sharply manifested and rapidly increasing. The child complains of severe shooting pain, aggravated by swallowing, coughing, yawning, etc. In addition, the patient develops symptoms such as hearing loss, tinnitus, dizziness, fever, purulent discharge from the ear.

For internal otitis media, the following manifestations are characteristic: severe dizziness, often with an attack of nausea and vomiting, as well as loss of balance. In addition, the child may be disturbed by tinnitus or hearing loss.

Causes of otitis media

The main reason for the development of otitis media is bacterial, viral and fungal infections. In most cases, pathogenic microorganisms enter the ear from the nasal cavity or pharynx, being a complication of other infectious diseases – ARVI, tonsillitis, sinusitis, etc.However, cases of post-traumatic inflammation of the ear cavity are possible.

Factors contributing to the development of otitis media:

• Violation of the integrity of the tissues of the ear canal (scratches, abrasions).
• Injury of the tympanic membrane.
• Presence of infectious diseases of the upper respiratory tract.
• Decrease in the child’s immune system (may be associated with hypothermia, vitamin deficiency, chronic diseases, etc.).
• Anatomical features of the structure of the ENT organs (curvature of the nasal septum, a short wide auditory tube, practically without bends, etc.).
• Poor ear hygiene (using potentially dangerous cotton swabs, matches and other items that can damage the ear tissue when cleaning the ears).

Diagnosis of otitis media

The diagnosis of otitis media should be carried out exclusively by otolaryngologists. Excessive independence of parents in making a diagnosis and its treatment can cause irreparable harm to children’s health.

At the initial appointment, the doctor listens to the patient’s complaints, specifies the duration of the course of the symptoms of the disease, the presence of factors that could contribute to the development of otitis media (contacts with sick people, a history of chronic diseases, etc.). Having specified all the details, the ENT doctor proceeds to examine the patient. The most common method for assessing the condition of a child’s ear canals is otoscopy. During the examination, the doctor examines the ears with a special illuminated device – an otoscope.

In addition, an examination of the ear can be performed using endoscopy. The medical device endoscope allows you to examine in detail the ear canal and tympanic membrane of a small patient under magnification. In this case, the image is displayed on the screen, video recording is possible.

Other diagnostic methods required to confirm the diagnosis of Otitis media:

• Audiometry – helps the doctor assess hearing acuity.
• Blowing out the auditory tubes – it is necessary to determine the degree of their patency.
• Computed tomography – allows you to examine the temporal bone and identify the lesions of its structures, characteristic of purulent otitis media.
• Bacteriological analysis of ear discharge – helps to determine the type of infectious agent and select the optimal drug for treatment, taking into account the spectrum of sensitivity.

Otitis media

Treatment of otitis media requires an integrated approach aimed at combating the infectious agent, stopping unpleasant symptoms and achieving full recovery of the patient’s body. For this, both conservative and surgical treatment can be carried out.

Conservative therapy involves the use of the following methods of treatment of otitis media:

• Careful toilet of the ear canal.
• Taking antibiotics (for the bacterial nature of the disease).
• Using ear drops for pain relief.
• Application of turunda with special anti-inflammatory solutions.
• Antihistamines to relieve swelling in the ear cavity.
• Antipyretics (with concomitant increase in body temperature).

In addition, physiotherapeutic methods of treatment can be used: UFO, UHF therapy, laser therapy, electrophoresis, etc.They are used after the acute process subsides and contribute to the patient’s complete recovery and maximum recovery of damaged tissues.

In some cases, surgery may be required. The main methods of surgical treatment of otitis media:

• Bypassing the tympanic membrane – it is necessary to eliminate purulent fluid from the middle ear cavity.
• Tympanoplasty – helps to repair damaged structures of the middle ear and improve hearing.
• Paratentesis (tympanotomy) – is used to eliminate purulent contents in purulent otitis media.

Prevention of otitis media

In order to prevent the occurrence of otitis media, it is necessary to observe preventive measures:

• Strengthen the child’s immunity – provide a balanced diet, spend sufficient time in the fresh air, play sports, temper.
• Timely eliminate infectious diseases of the upper respiratory tract – rhinitis, sinusitis, tonsillitis, etc.
• To clean your ears correctly – do not insert the cotton swab beyond the external ear canal (wax formation is a natural protective process).
• Seek medical attention at first signs of otitis media.
• Do not self-medicate!

Treatment of otitis media in the clinic for children and adolescents “SM-Doctor” is the first-class professionalism of doctors, high-tech equipment and advanced methods of hearing restoration.

Otolaryngologists:

Children’s Clinic Metro Maryina Roscha

Mosina Ekaterina Ivanovna

Pediatric otolaryngologist, doctor of the highest category

Ignatenko (Tsivileva) Elena Vasilievna

Pediatric otolaryngologist, pediatric otolaryngologist-audiologist, operating specialist

Stepanova Svetlana Mikhailovna

Pediatric otolaryngologist, doctor of the highest category

Casanova Anna Vladimirovna

Pediatric otolaryngologist, operating specialist, doctor of the highest category, candidate of medical sciences

Gnezdilova Yulia Valerievna

Pediatric otolaryngologist, operating specialist

Shishkov Ruslan Vladimirovich

Pediatric otolaryngologist, pediatric oncologist, operating specialist, doctor of the highest category, professor, Ph.M.Sc.

Gorshkov Stepan Vyacheslavovich

Pediatric otolaryngologist, operating specialist

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Children’s clinic m.Voikovskaya

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Children’s clinic in Novye Cheryomushki metro station

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Children’s clinic m.Textile workers

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Children’s Clinic, Metro Molodezhnaya

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Children’s clinic m.Chertanovskaya

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Children’s Clinic, Moscow VDNKh

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Children’s Clinic in St.Solnechnogorsk, st. Red

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90,000 Does your ear hurt? This is otitis media …

What to do if the ear hurts, otolaryngologist Viktoria Evdokimova told.

The vast majority of ear diseases belong to the inflammatory group and have a common name – otitis media. Adults also suffer from otitis media, but rarely, it is more common in children.

During the first three years of life, about 80% of babies suffer from this disease at least once.What is the reason? A child has a shorter auditory tube than an adult. It is almost straight and has no bends. This structure makes it easier for the infection to enter the middle ear. Most often, otitis media develops as a complication of the common cold.

With acute respiratory infections or severe blowing of the nose, the infection enters the middle ear through the auditory tube.

Adenoids and chronic diseases of the oral cavity and pharynx can also cause otitis media. Less commonly, allergies or ear injuries are the cause.

In children and adults, the main symptoms of otitis media are the same:

• Hearing impairment (often, hearing is improved when the head position is changed).
• Severe pain in the ear, radiating to the temple.
• Temperature rise.
• Headache, vomiting, dizziness.
• In children under one year old, the only symptom of otitis media may be severe anxiety and crying.
• Symptoms of otitis media, as a rule, develop against the background of other symptoms of the common cold (ARI), several days after the onset of ARI.

At the first suspicion of an ear disease, in case of anxiety, an altered state of the child, it is necessary to call a pediatrician or ENT doctor to the house, and an adult should consult a specialist in a polyclinic, medical center. The doctor should determine the tactics of combating the disease and prescribe drugs.

“In case of a mild course of the disease, you may be advised to limit yourself to local treatment at home – lotions, ointments, balms,” says otolaryngologist Viktoria Evdokimova .- In severe cases, hospitalization is indicated and the addition of general therapy to local treatment – antibacterial, anti-inflammatory. If drug treatment is not effective, surgery is indicated. But this is usually a rare case. Conservative (non-surgical) treatment is usually sufficient. Therapy necessarily includes a course of antibiotics in the form of tablets or injections (with purulent otitis media) for at least 5-7 days. This is especially true for children under two years of age.This is done to prevent the development of complications. In addition, it is necessary to regularly use drugs for vasoconstriction (vasoconstrictor nasal drops), which maintains the patency of the auditory tube. Local treatment is also applied. As a rule, it is carried out at home, according to certain rules.

Compresses
If the doctor prescribed semi-alcohol or vodka compresses for the treatment of otitis media (compresses are contraindicated for suppuration from the ear), then they should be done as follows.Take a four-layer gauze napkin, the size of which should extend beyond the auricle by 1.5–2 cm. Make a slit for the ear in the middle. The napkin must be moistened in an alcohol solution or vodka, squeezed out, applied to the ear area (place the auricle in the slot). Put a compress (waxed) paper on top, slightly larger than gauze, and cover with a piece of cotton wool (the size should exceed the size of the paper). All this can be secured with a scarf tied around the head. The compress should be kept until it has a heat effect (3-4 hours).

Ear drops
Direct instillation of ear drops is dangerous. At home, you cannot examine the ear as the ENT doctor will do, and clarify the nature of the inflammation at the moment, see if the eardrum is damaged or not. If droplets enter the middle ear cavity when the eardrum ruptures, they can damage the ossicles or damage the auditory nerve, resulting in hearing loss. Instead, it is necessary to make a turunda out of dry cotton wool, carefully insert it into the external auditory canal and drip warm medicine onto the cotton ball 3-4 times a day.

A portion of the drops should be heated to body temperature (36.6 ° C).

You can, for example, heat the pipette in hot water, and then draw the medicine into it, or first draw the drug, and then heat the pipette with it in hot water. If a pipette-dispenser is attached to the bottle with drops, then it is convenient to heat in hot water that part of the medicine that will fit in the pipette when the bottle is turned over. Close the cap first.
You should not get carried away with self-medication, prescribe treatment on the recommendation of pharmacy employees or friends, give your child drugs, information about which is gleaned from advertising.Improper treatment or advanced ear disease is fraught with the development of meningitis in both children and adults.

Advice for moms

As you know, it is much easier to prevent a disease than to cure it. To reduce the risk of otitis media in a child, following a few simple rules will help:

1. It is advisable for babies to provide breast milk as long as possible. It is the source of the basic defenses of a small organism.
2. When feeding, it is best to keep the baby close to an upright position to avoid liquid entering the ear through the auditory tube.
3. Intelligent hardening also increases the body’s resistance.
4. If the baby does catch a cold, adults should remember when treating him that in the supine position in the nasopharynx, stagnation forms, increasing the risk of infection of the middle ear. It is necessary to remove the pathological contents from the nasal cavity with a suction-pear and periodically turn the crumbs from one side to the other.Sucking mucus with a pear should be done gently and slowly.

Ears have nothing to do with it …
In some diseases, pain can be given to the ear, while simulating ear disease. This can happen at:

• dental diseases,
• ulcerative and abscessing processes in the area of ​​the angle of the lower jaw, palatine tonsils, pharynx, larynx, as well as the entrance to the esophagus,
• neuritis and neuralgia of some cranial nerves (glossopharyngeal, vagus and intermediate nerves),
• neuralgia of the second and third branches of the cervical plexus.

Complications of inflammatory processes in the middle ear are rare, but can still occur:

• Hearing impairment. Usually they manifest themselves in the form of hearing loss, most often they are temporary.
• Ruptured tympanic membrane. When pus builds up in the middle ear, it can break through the eardrum.